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dOn Birth ConfcrolX
The Daily Tar HeelWednesday, November 8, 1 9895
By CHERYL ALLEN and MARA LEE
In the time it takes to make a piece of toast, a man
and a woman can make a baby.
Some students may not think about sex in those terms,
but for those who do, deciding on a method of birth
' control can be a hard choice.
Faced with the possibility of getting pregnant or con-
trading sexually transmitted diseases, students are forced
to make informed and sometimes uninformed
decisions about sex and birth control.
Getting the info
There are at least seven basic types of contraceptives
on the market today, each with its own distinctive
advantages and disadvantages, according to Student
Health Services (SHS) pamphlets.
: Effectiveness is one of students' primary concerns. A
. contraceptive's effectiveness can be measured in terms of
. theoretical and user effectiveness rates, said Peggy
Norton, nurse practitioner at SHS. "The theoretical rate
is the rate if everyone used it (birth control) correctly
. ,100 percent of the time," she said. "The user rate takes
, into account the fallibility of the user."
Abstinence, the most effective form of birth control,
is practiced by some students. "We're seeing a lot of
folks not sexually active as early," Norton said. "I think
AIDS has done something for that."
When trying to decide on a form of contraception,
I many students choose to go to other medical clinics in the
' area rather than going to SHS, Norton said.
Students who do come to SHS seeking advice about
contraceptives choose a method of contraception entirely
on their own, said Norton, who is the author of most of
the SHS pamphlets dealing with contraceptives and
sexually transmitted diseases (STDs).
If students have questions or are unsure about different
methods of birth control, they are referred to a Contracep
tive Health Education Clinic (CHEC) counselor, Norton
CHEC counselors talk with students about the advan
tages, disadvantages, effectiveness and cost of various
" methods of birth control, said Ruth Ann Grissom, a
. CHEC counselor.
1.' Using general information about students' sexuality,
.. CHEC counselors help them make an informed decision
about what method is best for them, said CHEC counselor
The Pill's popularity
With the exceptions of abstinence and sterilization, the
Oral Contraceptive Pill is the most reliable method of
" preventing pregnancy, according to SHS pamphlets.
'The birth control pill is always the most common se
lection," Norton said. "It's the easiest, simplest and most
' effective with very few side effects."
The Pill prevents ovulation, or the release of the egg
from the ovary. It also affects the lining of the uterus and
the mucus produced by the cervix to make pregnancy less
probable if an egg were released.
Sixty-two percent of sexually active women in the
United States between the ages of 20 and 24 have used
the Pill at some time;' according to a 1982 study
conducted by the U.S., Department of Health and
Human Services. Thirty-one percent of women between
the ages of 20 and 24 now use the Pill.
'. Some women complain of weight gain and nausea
while on the Pill. "We see women who are afraid of the
side effects of the Pill," said Janet Colm, executive
' director of Planned Parenthood of Orange County.
V - I
i 1 ,fl t;
Peggy Norton displays birth control devices
"Teenage women are afraid of (the discomfort of) the
pelvic exam needed to go on the Pill."
The Pill is not recommended for women with a history
of blood-clotting problems, severe kidney, liver or cardiac
diseases or those who smoke.
The Pill's theoretical effectiveness rate is 99.5
percent; its actual user rate is 98 percent, allowing for
women who forget to take it or those who take it at
different times each day. Besides being the most
effective type of contraceptive, the Pill also allows for
spontaneous sexual intercourse, according to SHS.
The Pill costs $6.50 a package (for a month's supply) at
SHS. At an off-campus pharmacy, a package costs
between $10 and $13.
But the Pill does hot prevent STDs. According to
Norton "Even if a woman chooses pills, we still encour
age condom use."
Students should keep in mind that STDs are more
dangerous to women than they are to men. "STDs are
biologically sexist," Pahel-Short said. "Women have more
serious health consequences as a result of STDs. They can
become sterile or predisposed to an increased risk of
cancer. Women need to assert their right to be protected.
They should insist on condom use."
Stocking up on condoms
It might be a misrepresentation of what's happening on
campus to say that the Pill is the most popular form of
birth control, Grissom said.
SHS sees only women who need a prescription for
contraceptives and does not take into account the
number of students using condoms, she said.
Machines on campus sold about 1,450 condoms in
the first six weeks of school, said Rutledge Tufts,
general manager of Student Stores.
The theoretical effectiveness rate for condoms is 98
percent, but a user effectiveness rate of 90 percent
reflects breakage and inconsistent or incorrect use.
"Supposedly the condom rate is 98 percent, but that's
if it's used correctly all the time," said Mark Anderson,
a junior journalism major from Louisville, Ky. "It's not.
Most (of the people who use it) don't use it all the
Condoms prevent semen from entering the vagina
during intercourse. They are available over the counter
and prevent the spread of STDs. Condoms also require
the male partner to be involved directly in the contra
Although exact statistics were not available, con
doms are the No. 1 selling over-the-counter birth
control method, said Mac McCullen, store manager of
Kerr Drugs in University Mall.
A package of 12 condoms costs
between $2.70 and $3.45 at SHS. At
an outside pharmacy, a package costs
between $3.50 and $6.
For women only
Other chemical and mechanical
means of birth control are available
with or without a prescription.
The diaphragm is a rubber-covered
ring that holds spermicide over the
cervix during intercourse. It acts as a
barrier to the uterus while the
spermicide kills sperm.
The diaphragm does not have
serious side effects, but its effective
ness is highly dependent on the user.
Rates of success vary from 81 to 98
According to SHS pamphlets, the
diaphragm is not as effective as the
Pill or intrauterine devices, but it is a
viable option for many women
A diaphragm costs $7 at SHS and
between $10.50 and $15 at an off
Another option is the cervical cap,
a rubber cap fitted to hold spermicide
over the cervix. The cap is similar to the diaphragm, but
is smaller and requires less spermicide.
Though the cap's effectiveness is supposed to be the
same as to the diaphragm's, Norton said SHS had found it
to be noticeably less effective.
"We were a test site (for a study) and we recorded a
33 percent pregnancy rate with the cap," Norton said.
For that reason, SHS does not distribute cervical caps.
Intrauterine devices (IUDs) are plastic devices a
health care professional inserts in the uterus. Exactly
why IUDs prevent pregnancy is still unknown, but
" don't think that
there's a really
good method of
There's lots of
methods, and all
of them have
lining to prevent a fertilized egg from implanting itself
Effectiveness rates range from a theoretical 98.5
percent to a 95 percent user rate, but IUDs pose a number
of risks. The greatest risk is the possibility of a perforating
the uterus or contracting "Pelvic Inflammatory Disease," a
severe infection of the female internal organs that may
cause sterility or require a hysterectomy.
Another birth control method is disposable foam
sponges filled with chemical spermicide, acting like a
disposable diaphragm. They block and kill sperm when
placed over the cervix.
The theoretical effectiveness rate is as high as 9 1
percent, but user rates show an 84 to 87 percent effective
Sponges, which can be bought over the counter, may be
inserted up to 24 hours before intercourse. Besides the
lower effectiveness rate, the only significant disadvantage
is the risk of toxic shock syndrome.
A package of three sponges costs $3.95 at SHS and
between $3 and $5 at an off-campus pharmacy.
Spermicides come in several forms: jellies, creams,
foams and suppositories. A new vaginal contraceptive
film now on the market acts as a barrier and a spermicide
since the small square film is folded and inserted high in
Spermicides contain chemicals that deactivate or kill
sperm and are most effective when used with other
contraceptive methods. Spermicides cost $6 at SHS and
between $5 and $10 at an off-campus pharmacy.
Condoms and foam have a combined effectiveness rate
of 95 percent. When used alone, however, spermicides
can cause a relatively high pregnancy rate.
Spermicides have no serious side effects. They also
may offer slight protection against sexually transmitted
In the end, the decision is a personal one, Pahel-Short
said. "Some women want the diaphragm. Some are !
comfortable with sponges. Some couples continue to use
The drug-free options
Two other birth control options are withdrawal and the
rhythm method. Withdrawal, or removing the penis from
the vagina before ejaculation, has an effectiveness rate, of
only 75 to 80 percent. '.
Fertility awareness, or the rhythm method, requires the
female to take her temperature daily for several months
and look for changes in cervical mucus to determineithe
"safe" weeks for intercourse during her cycle.
A qualified instructor should teach this method,
which takes six months of monitoring before inter
course should occur. The user effectiveness rate of the
rhythm method ranges from 76 to 80 percent.
But health professionals and students take a skeptical
view of these methods.
"I wouldn't use withdrawal," said Michael Amend, a
junior business major from Hudson, Ohio. "I don't
consider that birth control I consider that as playing
the lottery or Russian roulette."
Most students agreed birth control was an important
consideration for them. In fact, many said they , would
use more than one method of birth control. "I would, use
all of them," said Tracy Dowdy, a freshman interna-!
tional studies major from Charlotte. "I would take every
. precaution possible to not get preg
But Scott Roberts, a junior philoso--phy
major from Gastonia, said he Y
could see times when he wouldn't use
any birth control at all, like "when
there weren't any (other methods)
Students should recognize that all
methods have their imperfections.
"I don't think that there's a really
good method of birth control," said
Colm, the executive director of
Planned Parenthood for Orange
County. "There's lots of methods,
and all of them have drawbacks."
many researchers believe the devices affect the uterus's be combined.
Whose responsibility is it?
Students agreed that contraceptives
are both partners' responsibility, but
society also must take responsibility.
"Society (has responsibility) in
making information available," '
Amend said. "It's not available early
enough. I know people who had sex
in junior high and they knew nothing
about it." ;
Students also agreed that responsi
bility for contraception should be
shared, even down to sharing the cost. "Birth control isn't
the most expensive thing in the world, but it's not ultra
cheap either," Anderson said. "Both should always be
making sure that the birth control is going right." '
An even more tangible way of sharing would be for "
both the male and female to use a method, such as the Pill
and a condom or a condom and spermicide, Dowdy
Buff Grace, a junior English major from Social Circle,
Ga., agreed. "The decision to have sex should be com
bined, and so the decision about contraceptives should
More convenient contraceptives predicted for 1 990s
By D'ANN PLETCHER
Despite setbacks from right-to-lif-ers
and conservative White House
administrations, birth control re
searchers are making strides to bene
fit women of the 1990s.
Many innovations in birth control
are simply improvements on past
technology, said Dr. Malcolm Potts,
a reproductive biologist and presi
dent of Family Health International
(FHI), a non-profit group in Research
The Federal Drug Administration
(FDA) already has approved active
ingredients like progesterone, which
have been put into devices such as the
Norplant or have been developed into
injections such as the Depro Provera
shot. Both free women from a troub
lesome daily dosage, Potts said.
But one of the most significant
research achievements probably will
not benefit women of the 1990s at
least not American women. Roussel
Uclaf, a French company, has devel
oped RU-486, a 95 percent effective
pill that induces menstruation and ends
pregnancy up to six weeks after inter
course. Potts said the drug was also effective
in treating advanced breast cancer and
some types of cerebral tumors.
However, the drug probably will
never receive FDA approval for any
type of use, contraceptive or otherwise,
because of opposition from the pro-life
movement. Pro-life advocates, who
have dubbed the pill "French death,"
feel RU-486 is too similar to abortion,
even though its use requires no surgical
"The problem is political," Potts said.
"The American extreme has frightened
the French company into thinking it
will lose money in sales of its other
contraceptive products, through a boy
cott, if it even tries to get the drug
approved in this country."
Dr. Joanne Steane, who counsels and
prescribes contraceptives to women at
the UNC Student Health Services, said
RU-486 is "much safer and easier than
abortion; It requires no anesthesia and
there is no chance of damage to the
reproductive system. A drawback is
that follow-ups must be made because
occasionally a pregnancy is not com
Peggy Norton, a nurse practitioner at
the UNC Student Health Services, also
sees limited opportunity for the drug
becoming available in the United States
"We'll never get it here not as long
as we've got Jesse Helms and George
Bush," she said.
Among the innovations that Potts
said would be on the market soon were
Norplant (within six months to a year)
and the female condom (within the next
Norplant consists of six tiny rods
implanted into the arm with local anes
thesia and a five-minute surgical pro
cedure. Though the implant leaves a
slight scar, the rods are painless once
inserted, Norton said.
Norplant is effective for five years
and may be removed at any time. The
most common side effects are irregular
menstrual cycles and prolonged bleed
ing. While some experts have suggested
that young women might be afraid of
trying long-term birth control methods
like Norplant because of contradictory
feelings about birth control and sexual
ity, Norton said she doesn't feel this
will be the case among college women.
"By the time a woman reaches col
lege, she is usually comfortable with
her sexuality," Norton said. "I think the
Norplant will be popular among col
A new reversible sterilization proce
dure that caps the Fallopian tube with a
fimbrial hood "resembling a light bulb"
might also be popular among college
women, Norton said.
The advantages would be a decrease
in pelvic inflammatory disease caused
by other non-Pill methods such as the
intrauterine device (IUD), and the alle
viation of the Pill-related risk of breast
cancer. The new method also takes up
less of the Fallopian tube than older
methods and is more easily reversed.
Although sterilization is the most
popular method of birth control in the
United States, Potts does not recom
mend it for women who wish to have
children some day, even if the proce
dure is supposed to be reversible. "There
really aren't any guarantees," he said.
The female condom, also called in
travaginal pouches, may help prevent
the spread of sexually transmitted dis
eases, in addition to guarding against
One model of the female condom
now being studied in the United States
has two rings. One ring functions like a
diaphragm and prevents the passage of
sperm. The other lies at the opening of
the vagina and is lubricated with sper
FHI is also working on a new prod
uct of its own, a hormone shot called
Norethindrone. The shot is similar to,
other hormone shots but more sophism '
ticated, Potts said.
By comparison, the Depro Provera
shots, which already have received
FDA approval for non-contraceptive
treatments, will soon be approved as
a birth control method. Known as
"Model T's," Norethindrone causes
few irregular periods and less between-period
spotting. Potts said.
But Potts advised those seeking
the "perfect" contraceptive device to
give up. "None of the options are
perfect, but there are many that are
pretty good, and they're getting bet
ter," he said. "It boils down to a mat
ter of choice, like whether you want
to cruise around in a convertible or a
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